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Concussion Information

  • Concussion Information Sheet
  • Acknowledgement of having received the "Ohio Department of Health's Concussion and Head Injury Information Sheet"

    By signing this form, as the parent/guarding/care-giver of the student-athlete named below, I acknowledge receiving a copy of the concussion and head injury information sheet prepared by the Ohio Department of Health as required by section 3313.539 of the Revised Code.

    I understand concussions and other head injuries have serious and possibly long-lasting effects.

    By reading the information sheet, I understand I have responsibility to report any signs or symptoms of a concussion or head injury to coaches, administrators and my student-athlete's doctor.

    I also understand that coaches, referees and other officials have a responsibility to protect the health of the student-athletes and may prohibit my student-athlete from further participation in athletic programs until my student-athlete has been cleared to return by a physician or other appropriate health care professional.
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